Psoriatic arthritis and pregnancy: maternal and neonatal outcomes in a clinical cohort

Year 2026, Volume: 8 Issue: 1, 146 - 152, 06.01.2026

Murad Gezer , Ümit Taşdemir , Sevdenur Yiğit , Halise Hande Gezer , Sevtap Acer , Özlem Pehlivan

https://doi.org/10.38053/acmj.1835573

Abstract

Aims: To evaluate obstetric and neonatal outcomes in women with psoriatic arthritis (PsA) by comparing pregnancies before and after diagnosis, as well as with healthy controls, with a focus on disease activity, treatment exposure, and flares
Methods: This retrospective cross-sectional study included 227 pregnancies from 85 women with PsA and 100 pregnancies from 46 healthy controls. Maternal and neonatal outcomes were assessed, including preeclampsia, gestational hypertension, gestational diabetes, cesarean delivery, preterm birth, small for gestational age (SGA), congenital anomalies, and neonatal intensive care unit (NICU) admissions. Disease activity and flares during pregnancy were recorded. Logistic regression analyses were performed to identify predictors of composite adverse maternal and neonatal outcomes.
Results: Among PsA pregnancies, 161 (71%) occurred before and 66 (29%) after diagnosis. Maternal age at conception was higher post-diagnosis, and these pregnancies showed increased rates of cesarean delivery (60.4% vs. 16.9% and 14.5%, p<0.001), preeclampsia (11.3% vs. 0.7%, p<0.001), gestational diabetes (11.3% vs. 2.9%, p=0.03), and gestational hypertension (11.3% vs. 7.4% and 2.4%, p=0.03). Composite adverse maternal outcomes were more frequent after PsA diagnosis compared with both pre-diagnosis pregnancies and controls. For neonatal outcomes, SGA was significantly more common after diagnosis (17% vs. 6.6% and 2.4%, p=0.02 and p=0.002), and NICU admissions were increased compared with pre-diagnosis pregnancies (18.9% vs. 6.6%, p=0.01). Logistic regression identified advanced maternal age as an independent predictor of adverse maternal outcomes, whereas no independent predictors were found for neonatal outcomes.
Conclusion: In pregnancies with PSA, adverse maternal outcomes are more frequent, especially after diagnosis, whereas neonatal outcomes are generally comparable to control groups, with an increased frequency of SGA. Given the impact of advanced maternal age, disease activity, and treatment exposure, close monitoring and individualized management are necessary to achieve the best outcomes for both mother and baby.

Keywords

Psoriatic arthritis , pregnancy , obstetric outcomes , neonatal outcomes , disease activity

Ethical Statement

The study obtained acceptance from the ethics committee of Ümraniye Training and Research Hospital (Date and number: 16.01.2025/476) and was executed consistent with the Declaration of Helsinki.

References

• Madland TM, Apalset EM, Johannessen AE, Rossebö B, Brun JG. Prevalence, disease manifestations, and treatment of psoriatic arthritis in Western Norway. J Rheumatol. 2005;32(10):1918-1922.
• Alinaghi F, Calov M, Kristensen LE, et al. Prevalence of psoriatic arthritis in patients with psoriasis: a systematic review and meta-analysis of observational and clinical studies. J Am Acad Dermatol. 2019;80(1):251-265.e19. doi:10.1016/j.jaad.2018.06.027
• Bröms G, Haerskjold A, Granath F, Kieler H, Pedersen L, Berglind IA. Effect of maternal psoriasis on pregnancy and birth outcomes: a population-based cohort study from denmark and sweden. Acta Derm Venereol. 2018;98(8):728-734. doi:10.2340/00015555-2923
• Smith CJF, Bandoli G, Kavanaugh A, Chambers CD. Birth outcomes and disease activity during pregnancy in a prospective cohort of women with psoriatic arthritis and ankylosing spondylitis. Arthritis Care Res (Hoboken). 2020;72(7):1029-1037. doi:10.1002/acr.23924
• Mørk S, Voss A, Möller S, Bliddal M. Spondyloarthritis and outcomes in pregnancy and labor: a nationwide register-based cohort study. Arthritis Care Res (Hoboken). 2021;73(2):282-288. doi:10.1002/acr.24111
• Eudy AM, McDaniel G, Clowse ME. Pregnancy outcomes, fertility, and family planning in women with psoriatic arthritis. Obstet Med. 2020;13 (2):70-75. doi:10.1177/1753495X18820463
• Strouse J, Donovan BM, Fatima M, et al. Impact of autoimmune rheumatic diseases on birth outcomes: a population-based study. RMD Open. 2019;5(1):e000878. doi:10.1136/rmdopen-2018-000878
• Remaeus K, Johansson K, Granath F, Stephansson O, Hellgren K. Pregnancy outcomes in women with psoriatic arthritis in relation to presence and timing of antirheumatic treatment. Arthritis Rheumatol. 2022;74(3):486-495. doi:10.1002/art.41985
• Taylor W, Gladman D, Helliwell P, et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006;54(8):2665-2673. doi:10.1002/art.21972
• Ritchlin CT, Colbert RA, Gladman DD. Psoriatic arthritis. N Engl J Med. 2017;376(10):957-970. doi:10.1056/NEJMra1505557
• Coates LC, Soriano ER, Corp N, et al. Group for research and assessment of psoriasis and psoriatic arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021. Nature Reviews Rheumatology. 2022;18:465-479.
• Fetal growth restriction: ACOG Practice Bulletin, Number 227. Obstet Gynecol. 2021;137(2):e16-e28. doi:10.1097/AOG.0000000000004251
• Gestational hypertension and preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020;135(6):e237-e260. doi:10.1097/AOG. 0000000000003891
• Meissner Y, Rudi T, Fischer-Betz R, Strangfeld A. Pregnancy in women with psoriatic arthritis: a systematic literature review of disease activity and adverse pregnancy outcomes. Semin Arthritis Rheum. 2021;51(3):5 30-538. doi:10.1016/j.semarthrit.2021.04.003
• Polachek A, Polachek Shlomi I, Spitzer K, et al. Outcome of pregnancy in women with psoriatic arthritis compared to healthy controls. Clin Rheumatol. 2019;38(3):895-902. doi:10.1007/s10067-018-4385-7
• Rüegg L, Pluma A, Hamroun S, et al. EULAR recommendations for use of antirheumatic drugs in reproduction, pregnancy, and lactation: 2024 update. Ann Rheum Dis. 2025;84(6):910-926. doi:10.1016/j.ard.2025.02. 023
• Clowse MEB, Scheuerle AE, Chambers C, et al. Pregnancy outcomes after exposure to certolizumab pegol: updated results from a pharmacovigilance safety database. Arthritis Rheumatol. 2018;70(9):13 99-1407. doi:10.1002/art.40508
• Allen KD, Kiefer MK, Butnariu M, Afzali A. Pregnant women with immune mediated inflammatory diseases who discontinue biologics have higher rates of disease flare. Arch Gynecol Obstet. 2022;306(6):1929-1937. doi:10.1007/s00404-022-06463-x
• Gangbe EM, Badeghiesh A, Baghlaf H, Dahan MH. Pregnancy, delivery, and neonatal outcomes among women with psoriatic arthritis, a population based study. J Perinat Med. 2022;50(5):581-586. doi:10.1515/j pm-2021-0468
• Tsao NW, Hanley GE, Lynd LD, Amiri N, De Vera MA. Risk of congenital anomalies in infants born to women with autoimmune disease using biologics before or during pregnancy: a population-based cohort study. Clin Exp Rheumatol. 2019;37(6):976-982.
• Tsao NW, Rebic N, Lynd LD, De Vera MA. Maternal and neonatal outcomes associated with biologic exposure before and during pregnancy in women with inflammatory systemic diseases: a systematic review and meta-analysis of observational studies. Rheumatology (Oxford). 2020;59(8):1808-1817. doi:10.1093/rheumatology/keaa064
• Ursin K, Lydersen S, Skomsvoll JF, Wallenius M. Psoriatic arthritis disease activity during and after pregnancy: a prospective multicenter study. Arthritis Care Res (Hoboken). 2019;71(8):1092-1100. doi:10.1002/acr.23747